Leukoplakia

A 39-year-old man was concerned that his history of long-termnicotine exposure placed him at increased risk forthroat cancer. He had used about 2 cans of "dip" each weekfor many years. The patient habitually placed the tobaccoin the right lower lip area; to avoid spitting, he always swallowedthe spent wad. The patient did not smoke; he usedalcohol occasionally.Lesions on the buccal mucosa were noted during theexamination; a full nasolaryngoscopy was performed.Chronic cryptic adenitis also was found, and the patientwas referred to an ear, nose, and throat specialist.The mucosal lesions were diagnosed as focal leukoplakiaand hyperkeratosis--both of which are precancerouslesions. Because there was no evidence of malignancy,a biopsy was not performed. The patient was counseled tostop the use of tobacco and to return for frequent follow-upexaminations. Sustained-release bupropion, 150 mg bid,was prescribed.Squamous cell carcinoma develops in up to 17% of patientswith leukoplakia; another 24% have some form of dysplasia.Many of these lesions spontaneously involute whentobacco use ceases.¹(Case and photograph courtesy of Dr Kenneth LeCroy.)